Multicenter Study

. 2015 Jul;46(7):1850-6.

doi: 10.1161/STROKEAHA.115.009215. Epub 2015 May 14.

Hemodynamic Features of Symptomatic Vertebrobasilar Disease

Sepideh Amin-Hanjani¹, Xinjian Du², Linda Rose-Finnell², Dilip K Pandey², DeJuran Richardson², Keith R Thulborn², Mitchell S V Elkind², Gregory J Zipfel², David S Liebeskind², Frank L Silver², Scott E Kasner², Victor A Aletich², Louis R Caplan², Colin P Derdeyn², Philip B Gorelick², Fady T Charbel²; VERiTAS Study Group

Collaborators, Affiliations

Collaborators

VERiTAS Study Group:
Hui Xie, Michael P Flannery, Hagai Ganin, Sean Ruland, Rebecca Grysiewicz, Aslam Khaja, Laura Pedelty, Fernando Testai, Archie Ong, Noam Epstein, Hurmina Muqtadar, Karriem Watson, Nada Mlinarevich, Maureen Hillmann, Joy Hirsch, Stephen Dashnaw, Philip M Meyers, Josh Z Willey, Edwina McNeill-Simaan, Veronica Perez, Alberto Canaan, Wayna Paulino-Hernandez, Katie Vo, Glenn Foster, Andria Ford, Abdullah Nassief, Abbie Bradley, Jannie Serna-Northway, Kristi Kraus, Lina Shiwani, Nancy Hantler, Jeffrey Alger, Sergio Godinez, Jeffrey L Saver, Latisha Ali, Doojin Kim, Matthew Tenser, Michael Froehler, Radoslav Raychev, Sarah Song, Bruce Ovbiagele, Hermelinda Abcede, Peter Adamczyk, Neal Rao, Anil Yallapragada, Royya Modir, Jason Hinman, Aaron Tansy, Mateo Calderon-Arnulphi, Sunil Sheth, Alireza Noorian, Kwan Ng, Conrad Liang, Jignesh Gadhia, Hannah Smith, Gilda Avila, Johanna Avelar, David Mikulis, Jorn Fierstra, Eugen Hlasny, Leanne K Casaubon, Mervyn Vergouwen, J C Martin Del Campo, Cheryl S Jaigobin, Cherissa Astorga, Libby Kalman, Jeffrey Kramer, Susan Vaughan, Laura Owens, Brett Kissela, Tanya N Turan, Tom P Jacobs, Scott Janis

Affiliations

¹ From the Department of Neurosurgery (S.A.-H., X.D., L.R.-F., V.A.A., F.T.C.), Department of Neurology and Rehabilitation (D.K.P., D.R.), and Center for Magnetic Resonance Research (K.R.T.), University of Illinois at Chicago; Department of Mathematics and Computer Science, Lake Forest College, IL (D.R.); Departments of Neurology and Epidemiology, Columbia University, New York, NY (M.S.V.E.); Departments of Neurosurgery and Neurology, Washington University in St. Louis, MO (G.J.Z., C.P.D.); Department of Neurology, University of California at Los Angeles (D.S.L.); Division of Neurology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada (F.L.S.); Department of Neurology, University of Pennsylvania, Philadelphia (S.E.K.); Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA (L.R.C.); Departments of Radiology, Neurology and Neurological Surgery, Mallinkrodt Institute of Radiology, Washington University in St. Louis, MO (C.P.D.); and Department of Translational Science and Molecular Medicine, Michigan State University College of Human Medicine, and Mercy Health Hauenstein Neurosciences, Grand Rapids (P.B.G.). hanjani@uic.edu.
² From the Department of Neurosurgery (S.A.-H., X.D., L.R.-F., V.A.A., F.T.C.), Department of Neurology and Rehabilitation (D.K.P., D.R.), and Center for Magnetic Resonance Research (K.R.T.), University of Illinois at Chicago; Department of Mathematics and Computer Science, Lake Forest College, IL (D.R.); Departments of Neurology and Epidemiology, Columbia University, New York, NY (M.S.V.E.); Departments of Neurosurgery and Neurology, Washington University in St. Louis, MO (G.J.Z., C.P.D.); Department of Neurology, University of California at Los Angeles (D.S.L.); Division of Neurology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada (F.L.S.); Department of Neurology, University of Pennsylvania, Philadelphia (S.E.K.); Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA (L.R.C.); Departments of Radiology, Neurology and Neurological Surgery, Mallinkrodt Institute of Radiology, Washington University in St. Louis, MO (C.P.D.); and Department of Translational Science and Molecular Medicine, Michigan State University College of Human Medicine, and Mercy Health Hauenstein Neurosciences, Grand Rapids (P.B.G.).

PMID: 25977279
PMCID: PMC4607265
DOI: 10.1161/STROKEAHA.115.009215

Multicenter Study

Hemodynamic Features of Symptomatic Vertebrobasilar Disease

Sepideh Amin-Hanjani et al. Stroke. 2015 Jul.

. 2015 Jul;46(7):1850-6.

doi: 10.1161/STROKEAHA.115.009215. Epub 2015 May 14.

Authors

Collaborators

VERiTAS Study Group:
Hui Xie, Michael P Flannery, Hagai Ganin, Sean Ruland, Rebecca Grysiewicz, Aslam Khaja, Laura Pedelty, Fernando Testai, Archie Ong, Noam Epstein, Hurmina Muqtadar, Karriem Watson, Nada Mlinarevich, Maureen Hillmann, Joy Hirsch, Stephen Dashnaw, Philip M Meyers, Josh Z Willey, Edwina McNeill-Simaan, Veronica Perez, Alberto Canaan, Wayna Paulino-Hernandez, Katie Vo, Glenn Foster, Andria Ford, Abdullah Nassief, Abbie Bradley, Jannie Serna-Northway, Kristi Kraus, Lina Shiwani, Nancy Hantler, Jeffrey Alger, Sergio Godinez, Jeffrey L Saver, Latisha Ali, Doojin Kim, Matthew Tenser, Michael Froehler, Radoslav Raychev, Sarah Song, Bruce Ovbiagele, Hermelinda Abcede, Peter Adamczyk, Neal Rao, Anil Yallapragada, Royya Modir, Jason Hinman, Aaron Tansy, Mateo Calderon-Arnulphi, Sunil Sheth, Alireza Noorian, Kwan Ng, Conrad Liang, Jignesh Gadhia, Hannah Smith, Gilda Avila, Johanna Avelar, David Mikulis, Jorn Fierstra, Eugen Hlasny, Leanne K Casaubon, Mervyn Vergouwen, J C Martin Del Campo, Cheryl S Jaigobin, Cherissa Astorga, Libby Kalman, Jeffrey Kramer, Susan Vaughan, Laura Owens, Brett Kissela, Tanya N Turan, Tom P Jacobs, Scott Janis

Affiliations

¹ From the Department of Neurosurgery (S.A.-H., X.D., L.R.-F., V.A.A., F.T.C.), Department of Neurology and Rehabilitation (D.K.P., D.R.), and Center for Magnetic Resonance Research (K.R.T.), University of Illinois at Chicago; Department of Mathematics and Computer Science, Lake Forest College, IL (D.R.); Departments of Neurology and Epidemiology, Columbia University, New York, NY (M.S.V.E.); Departments of Neurosurgery and Neurology, Washington University in St. Louis, MO (G.J.Z., C.P.D.); Department of Neurology, University of California at Los Angeles (D.S.L.); Division of Neurology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada (F.L.S.); Department of Neurology, University of Pennsylvania, Philadelphia (S.E.K.); Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA (L.R.C.); Departments of Radiology, Neurology and Neurological Surgery, Mallinkrodt Institute of Radiology, Washington University in St. Louis, MO (C.P.D.); and Department of Translational Science and Molecular Medicine, Michigan State University College of Human Medicine, and Mercy Health Hauenstein Neurosciences, Grand Rapids (P.B.G.). hanjani@uic.edu.
² From the Department of Neurosurgery (S.A.-H., X.D., L.R.-F., V.A.A., F.T.C.), Department of Neurology and Rehabilitation (D.K.P., D.R.), and Center for Magnetic Resonance Research (K.R.T.), University of Illinois at Chicago; Department of Mathematics and Computer Science, Lake Forest College, IL (D.R.); Departments of Neurology and Epidemiology, Columbia University, New York, NY (M.S.V.E.); Departments of Neurosurgery and Neurology, Washington University in St. Louis, MO (G.J.Z., C.P.D.); Department of Neurology, University of California at Los Angeles (D.S.L.); Division of Neurology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada (F.L.S.); Department of Neurology, University of Pennsylvania, Philadelphia (S.E.K.); Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA (L.R.C.); Departments of Radiology, Neurology and Neurological Surgery, Mallinkrodt Institute of Radiology, Washington University in St. Louis, MO (C.P.D.); and Department of Translational Science and Molecular Medicine, Michigan State University College of Human Medicine, and Mercy Health Hauenstein Neurosciences, Grand Rapids (P.B.G.).

PMID: 25977279
PMCID: PMC4607265
DOI: 10.1161/STROKEAHA.115.009215

Abstract

Background and purpose: Atherosclerotic vertebrobasilar disease is an important cause of posterior circulation stroke. To examine the role of hemodynamic compromise, a prospective multicenter study, Vertebrobasilar Flow Evaluation and Risk of Transient Ischemic Attack and Stroke (VERiTAS), was conducted. Here, we report clinical features and vessel flow measurements from the study cohort.

Methods: Patients with recent vertebrobasilar transient ischemic attack or stroke and ≥50% atherosclerotic stenosis or occlusion in vertebral or basilar arteries (BA) were enrolled. Large-vessel flow in the vertebrobasilar territory was assessed using quantitative MRA.

Results: The cohort (n=72; 44% women) had a mean age of 65.6 years; 72% presented with ischemic stroke. Hypertension (93%) and hyperlipidemia (81%) were the most prevalent vascular risk factors. BA flows correlated negatively with percentage stenosis in the affected vessel and positively to the minimal diameter at the stenosis site (P<0.01). A relative threshold effect was evident, with flows dropping most significantly with ≥80% stenosis/occlusion (P<0.05). Tandem disease involving the BA and either/both vertebral arteries had the greatest negative impact on immediate downstream flow in the BA (43 mL/min versus 71 mL/min; P=0.01). Distal flow status assessment, based on an algorithm incorporating collateral flow by examining distal vessels (BA and posterior cerebral arteries), correlated neither with multifocality of disease nor with severity of the maximal stenosis.

Conclusions: Flow in stenotic posterior circulation vessels correlates with residual diameter and drops significantly with tandem disease. However, distal flow status, incorporating collateral capacity, is not well predicted by the severity or location of the disease.

Keywords: magnetic resonance angiography; magnetic resonance imaging; regional blood flow; stroke; vertebrobasilar ischemia.

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Figures

**Figure 1**
Correlation between flow in the BA in relation to stenosis (A) and to minimal BA luminal diameter (B) in a linear regression model.

**Figure 2**
Mean flows in the BA relative to degree of stenosis. * p= 0.02, ** p=0.08, *** p=0.05 using t-test comparison of groupings.

**Figure 3**
Theoretical relationships between blood flow and graded vessel stenosis (adapted, with permission, from Spencer MP and Reid JM)

See this image and copyright information in PMC

References

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Hemodynamic Features of Symptomatic Vertebrobasilar Disease

Collaborators

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Hemodynamic Features of Symptomatic Vertebrobasilar Disease

Authors

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Abstract

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Medical